This study evaluated long-term outcomes of 1292 ICU patients with acute kidney injury treated with renal replacement therapy (AKI-RRT) over an 8-year period. Mortality increased from 59.7% at hospital discharge to 72.1% at 3 years. Complete renal recovery occurred in 48.4% of hospital survivors at 1 year, while 19% required long-term dialysis. The composite endpoint of major adverse kidney events (MAKE), defined as death, incomplete renal recovery, or end-stage renal disease, increased from 83.1% at discharge to 93.7% at 3 years. Severity of illness, continuous RRT, older age, and comorbidities like diabetes and chronic kidney disease
This study investigated the incremental prognostic value of coronary and systemic atherosclerosis in 544 myocardial infarction patients. It found that greater longitudinal extent of coronary artery disease, as measured by the Sullivan extent score, was associated with higher rates of extra-cardiac artery disease, independent of clinical risk factors. Patients with both extensive coronary disease and extra-cardiac artery disease had significantly higher risks of all-cause mortality and cardiovascular hospitalization or death compared to those with limited disease in both vascular beds. The results suggest that assessing both coronary and extra-cardiac atherosclerosis provides important prognostic information for post-myocardial infarction patients.
This study analyzed angiographic data from 3,428 patients who underwent percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome in the ACUITY trial to determine the incidence and impact of intraprocedural thrombotic events (IPTE). IPTE occurred in 121 patients (3.5%) and was associated with significantly higher rates of major adverse cardiac events, including death, myocardial infarction, and stent thrombosis at in-hospital, 30-day, and 1-year follow-up compared to patients without IPTE. IPTE was an independent predictor of adverse outcomes at 30 days and 1 year after adjusting for other factors. The results suggest that although infrequent, IPTE during PCI for acute
The document summarizes economic analyses that have found transradial procedures to be more cost-effective than transfemoral procedures. Several studies are highlighted, including a registry analysis finding lower total inpatient costs and shorter length of stay for transradial PCI. A meta-analysis found transradial procedures were associated with lower complication rates and costs. For STEMI patients, studies demonstrated transradial procedures were linked to shorter hospital stays. The conclusions state that transradial access can improve value by enhancing outcomes and reducing length of stay, creating value across clinical scenarios.
The document discusses chronic kidney disease (CKD) and different machine learning algorithms that can be used to predict CKD. It first provides background on CKD, defining it as long-term damage to the kidneys that can progressively get worse over time. The document then reviews literature on predicting CKD and discusses methodologies like Naive Bayes, Decision Trees, K-Nearest Neighbors, and Support Vector Machines. It finds that the K-Nearest Neighbor algorithm produced the best results, with 98% accuracy in predicting CKD stages when applied to a dataset.
Nejm Effects of Aspirin for Primary Prevention in Persons with Diabetes MellitusBhargav Kiran
This document summarizes the results of the ASCEND trial, which investigated the effects of low-dose aspirin (100 mg daily) for primary prevention of cardiovascular events in 15,480 adults with diabetes but no history of cardiovascular disease. Over a mean follow-up of 7.4 years:
- Serious vascular events were lower in the aspirin group (8.5%) compared to placebo (9.6%), but major bleeding events were higher with aspirin (4.1% vs 3.2%).
- There was no significant difference in gastrointestinal cancer rates between groups.
- Aspirin prevented some vascular events but increased bleeding, largely offsetting the benefits. The absolute risks and benefits were closely balanced
A retrospective chart review was conducted of 91 patients admitted with sepsis between 2013-2014 to examine outcomes of central venous catheters (CVCs) and arterial catheters (ACs). 52 CVCs were placed in 36 patients and 48 ACs in 37 patients, with 32 receiving both. Of those with CVCs, 7 complications occurred in 10 patients (19% rate). Of those with ACs, 3 complications in 4 patients (8.1% rate). Logistic regression found no significant difference in mortality between those who received lines and those who did not, including among patients with higher illness scores. The study concludes that CVC and AC placement confers no significant improvement in survival for sepsis patients and can lead to unnecessary complications
1) High levels of soluble urokinase plasminogen activator receptor (suPAR) were associated with an increased risk of acute kidney injury in patients undergoing coronary angiography, cardiac surgery, and in critically ill patients.
2) Experiments in mice overexpressing suPAR and in human kidney cells exposed to suPAR showed that suPAR impairs kidney function and increases oxidative stress.
3) Blocking the urokinase plasminogen activator receptor with a monoclonal antibody prevented kidney injury in mice overexpressing suPAR and normalized cell function, suggesting suPAR contributes to acute kidney injury and its receptor is a potential therapeutic target.
This study investigated the incremental prognostic value of coronary and systemic atherosclerosis in 544 myocardial infarction patients. It found that greater longitudinal extent of coronary artery disease, as measured by the Sullivan extent score, was associated with higher rates of extra-cardiac artery disease, independent of clinical risk factors. Patients with both extensive coronary disease and extra-cardiac artery disease had significantly higher risks of all-cause mortality and cardiovascular hospitalization or death compared to those with limited disease in both vascular beds. The results suggest that assessing both coronary and extra-cardiac atherosclerosis provides important prognostic information for post-myocardial infarction patients.
This study analyzed angiographic data from 3,428 patients who underwent percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome in the ACUITY trial to determine the incidence and impact of intraprocedural thrombotic events (IPTE). IPTE occurred in 121 patients (3.5%) and was associated with significantly higher rates of major adverse cardiac events, including death, myocardial infarction, and stent thrombosis at in-hospital, 30-day, and 1-year follow-up compared to patients without IPTE. IPTE was an independent predictor of adverse outcomes at 30 days and 1 year after adjusting for other factors. The results suggest that although infrequent, IPTE during PCI for acute
The document summarizes economic analyses that have found transradial procedures to be more cost-effective than transfemoral procedures. Several studies are highlighted, including a registry analysis finding lower total inpatient costs and shorter length of stay for transradial PCI. A meta-analysis found transradial procedures were associated with lower complication rates and costs. For STEMI patients, studies demonstrated transradial procedures were linked to shorter hospital stays. The conclusions state that transradial access can improve value by enhancing outcomes and reducing length of stay, creating value across clinical scenarios.
The document discusses chronic kidney disease (CKD) and different machine learning algorithms that can be used to predict CKD. It first provides background on CKD, defining it as long-term damage to the kidneys that can progressively get worse over time. The document then reviews literature on predicting CKD and discusses methodologies like Naive Bayes, Decision Trees, K-Nearest Neighbors, and Support Vector Machines. It finds that the K-Nearest Neighbor algorithm produced the best results, with 98% accuracy in predicting CKD stages when applied to a dataset.
Nejm Effects of Aspirin for Primary Prevention in Persons with Diabetes MellitusBhargav Kiran
This document summarizes the results of the ASCEND trial, which investigated the effects of low-dose aspirin (100 mg daily) for primary prevention of cardiovascular events in 15,480 adults with diabetes but no history of cardiovascular disease. Over a mean follow-up of 7.4 years:
- Serious vascular events were lower in the aspirin group (8.5%) compared to placebo (9.6%), but major bleeding events were higher with aspirin (4.1% vs 3.2%).
- There was no significant difference in gastrointestinal cancer rates between groups.
- Aspirin prevented some vascular events but increased bleeding, largely offsetting the benefits. The absolute risks and benefits were closely balanced
A retrospective chart review was conducted of 91 patients admitted with sepsis between 2013-2014 to examine outcomes of central venous catheters (CVCs) and arterial catheters (ACs). 52 CVCs were placed in 36 patients and 48 ACs in 37 patients, with 32 receiving both. Of those with CVCs, 7 complications occurred in 10 patients (19% rate). Of those with ACs, 3 complications in 4 patients (8.1% rate). Logistic regression found no significant difference in mortality between those who received lines and those who did not, including among patients with higher illness scores. The study concludes that CVC and AC placement confers no significant improvement in survival for sepsis patients and can lead to unnecessary complications
1) High levels of soluble urokinase plasminogen activator receptor (suPAR) were associated with an increased risk of acute kidney injury in patients undergoing coronary angiography, cardiac surgery, and in critically ill patients.
2) Experiments in mice overexpressing suPAR and in human kidney cells exposed to suPAR showed that suPAR impairs kidney function and increases oxidative stress.
3) Blocking the urokinase plasminogen activator receptor with a monoclonal antibody prevented kidney injury in mice overexpressing suPAR and normalized cell function, suggesting suPAR contributes to acute kidney injury and its receptor is a potential therapeutic target.
Extended criteria donors in liver transplantation Part II reviewing the impac...Balázs Nemes
This document reviews the impact of extended-criteria donors on complications and outcomes of liver transplantation. It finds that extended-criteria donors are associated with higher risks of early allograft dysfunction, especially when donors have moderate to severe steatosis. Extended criteria donors also increase the risk of biliary complications and recurrence of hepatitis C virus. However, with new antiviral regimens, sustained virological response can be achieved in most patients. The use of extended criteria donors reduces long-term survival rates, with 1-year survival rates of 87% for low-risk donors and 40% for high-risk donors. Graft survival is excellent for donors up to a certain risk score but declines significantly above that threshold.
Introduction: Chronic Kidney Disease (CKD) is a worldwide public health problem and it is increasing over time. Cardiovascular disease is a major concern for patients with end stage renal disease, especially those on hemodialysis. It is the leading cause of death among patients with chronic kidney
disease, particularly in dialysis population.
This study analyzed transfusion practices over 5 years at SAQR Hospital in Ras Al Khaimah, UAE. A total of 7,045 blood units were transfused, with the highest use in surgical wards (33%), followed by road traffic accident victims (27%). The most common indications for transfusion were injuries from road traffic accidents, orthopedic surgeries, and cardiovascular surgeries. UAE nationals received the most transfusions, and the most common blood group was O positive. The majority of transfused blood products were packed red blood cells. The study concludes that regular assessment of blood usage and education sessions for clinicians could help ensure blood is used effectively for life-threatening situations.
This study assessed the impact of austerity measures in Greece on survival rates of out-of-hospital cardiac arrest victims. Data was collected from a Greek hospital on immediate and 24-hour survival pre-crisis (2007-2010) and during the crisis (2011-2014). Results showed no significant difference in return of spontaneous circulation or 24-hour survival between the two periods, suggesting healthcare workers were working hard to maintain standards despite budget cuts. However, overall survival rates remained low compared to international studies, highlighting the need for more Greek data on cardiac arrests.
This document presents a study on cardiac manifestations and electrocardiographic changes in patients with acute organophosphorus poisoning. The study analyzed hospital records of 100 patients with acute organophosphorus poisoning and found that 90% had tachycardia and 26% had hypertension while 24% had hypotension. Electrocardiograms showed 28% had prolonged QT intervals, 4% had ST changes, and 26% had T wave changes. The study concludes that cardiac complications are common in these patients and require continuous monitoring, even after clinical symptoms improve, as ECG changes can indicate prognosis.
ATC ABSTRACT 2006 - BOS - REVERSIBLE CAUSE OF BRONCHIOLITIS OBLITERANS SYNDR...Yavuz Silay
This study analyzed the impact of bronchial stenosis (BS) on graft function in lung transplant patients. Of the 34 patients studied over 2 years, 57% developed BS. Airway stents were placed in 39% of patients with BS who had a decline in FEV1. Patients with pulmonary fibrosis were more likely to develop BS. Patients who required stents had a more rapid decline in FEV1 than those without airway complications. Early intervention for BS may help slow graft function decline and prevent progression to bronchiolitis obliterans syndrome.
Elevated Tissue Doppler E/E' on Index Admission Can Help Identify Patients at...crimsonpublishersOJCHD
Readmissions for congestive Heart Failure (CHF) are a major healthcare problem that contributes significantly to the overall healthcare expenditure. About 24% of patients are readmitted to the hospital within 30 days of discharge. We investigated whether a non-invasive estimate of left atrial filling pressure, an elevated ratio of early trans mitral flow velocity to early diastolic mitral annular velocity (E/E'), during the index admission for CHF could independently predict 30 day readmission.
Journal of Stem Cell Research and Transplantation is an international, open access, peer reviewed, scholarly journal committed to publish articles in diversified fields of transplantations and applications of stem cell research. The aim of the academic journal is to provide a platform for researchers, scientists, physicians, and other health professionals to find latest research information in the areas of stem cell research, transplantations such as stem cell transplantation, transplantation immunology, kidney transplantation and its treatment. It is a wide-ranging Open Access peer reviewed scientific journal that covers multidisciplinary fields.
Journal of Stem Cell Research and Transplantation accepts original research articles, letter to editor, review articles, mini reviews, case reports, editorials, scientific data, technical reports, rapid communication, and short communications, etc. on all the aspects of stem cells. The Journal of Stem Cell Research and Transplantation publishes latest scientific information, and is generously accessible across the world through internet to go halves the innovations of the researchers for intellectual advancement in this field. Austin also brings universally peer reviewed scientific journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
This study analyzed trends in complications from 2000-2012 using a nationwide database of inpatient therapeutic ERCP procedures in the US. The study found:
1) Mortality rates decreased from 1.77% to 1.24%, and time series analysis confirmed this downward trend.
2) Perforation rates increased from 0.07% to 0.10% but time series analysis found no significant trend.
3) GI hemorrhage rates increased from 1.36% to 1.57% and time series analysis confirmed an upward trend.
The study concluded that while therapeutic ERCPs have become safer as shown by decreasing mortality rates, GI hemorrhage rates increased over the same period according to their analysis of
Access vs non-access site bleeding and risk of subsequent mortality and MACE
This study aimed to analyze the incidence and prognostic impact of access site versus non-access site bleeding in patients undergoing percutaneous coronary intervention (PCI). The meta-analysis included 38 studies and over 520,000 patients. It found that access site bleeding occurred in 11.2% of patients while non-access site bleeding occurred in 10.2% of patients. However, non-access site bleeding was associated with a higher crude mortality rate of 8.3% compared to 2.8% for access site bleeding. Further analyses confirmed that non-access site bleeding carried a greater risk of subsequent mortality and major adverse cardiac events than access site bleeding. The
This document summarizes modern management options for the uraemic syndrome in chronic kidney disease. It discusses the pathophysiology of the uraemic syndrome and how it affects multiple organ systems. Traditional and non-traditional risk factors for cardiovascular disease are examined. Over 150 uraemic retention products have been identified and are divided into small water-soluble compounds, protein-bound compounds, and larger middle molecules. Progression of chronic kidney disease depends on the underlying cause and risk factors, leading to loss of kidney function over time. Management options aim to target modifiable factors like cardiovascular risk simultaneously.
Purpose: To assess the effectiveness of a fast track referral system from Vascular Laboratory to Interventional Radiology on
threatened vein bypass grafts in the lower limbs.
Methods: A Fast Track System (FTS) was set up in February 2011 to minimise the delay from duplex scan to intervention for bypass grafts with identifi ed signifi cant stenoses. 111 scans were performed pre - FTS over one year and compared with 190 scans which were performed post-FTS introduction over two years.
Reversal of warfarin associated coagulopathy prothrombin complex concentratesTÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Raccomandazioni per la valutazione preoperatoria malattie remaliiClaudio Melloni
The document describes a study that developed an Acute Kidney Injury (AKI) risk index for patients undergoing general surgery. The study used data from over 75,000 patients to identify 11 independent preoperative predictors of AKI. These predictors were used to create a risk index with a high predictive capability (c statistic of 0.80). Patients who experienced AKI had an eightfold increase in 30-day mortality. The risk index can help identify patients at risk of AKI so preventative measures or closer monitoring can be taken.
This document discusses statistics related to heart failure. It summarizes data on outcomes for hospitalized heart failure patients compared to chronic heart failure patients. Hospitalized patients generally have worse outcomes, with high 1-year mortality rates around 25-27%. Chronic heart failure patients have lower but still significant 1-year mortality rates of around 5-6%. The document also reviews real-world data showing high readmission rates after hospitalization for heart failure. It concludes that while treatments for chronic heart failure with reduced ejection fraction have improved outcomes over decades, more efforts are still needed to improve care and outcomes for hospitalized patients and those with preserved ejection fraction.
2. continuous renal replacement therapy recent advances and future researchEdleo13
The document summarizes two large randomized controlled trials that provide new evidence to guide clinicians on the use of continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) in intensive care units (ICUs). The ATN and RENAL trials investigated different intensities of CRRT and found that effluent flow rates above 25 ml/kg per hour do not improve outcomes. The trials also established CRRT as the most appropriate treatment for vasopressor-dependent AKI patients in the ICU. However, questions remain regarding optimal initiation thresholds and timing of CRRT.
When to Initiate RRT in Patients with AKI - Does Timing Matter?Apollo Hospitals
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT.
When to initiate RRT in patients with AKI - Does timing matter?Apollo Hospitals
When to initiate RRT in patients with AKI remains an area of debate due to lack of consensus on the optimal timing. The document reviews evidence on using various biochemical parameters and clinical indicators to guide RRT initiation. Studies have shown conflicting results for triggers like serum creatinine, urea, and oliguria. Earlier initiation of RRT may improve outcomes by preventing fluid overload, though high-quality randomized trials are still needed to definitively establish best practices. The cause of AKI and individual patient factors are also important considerations in determining optimal timing.
When to Initiate RRT in Patients with AKI - Does Timing Matter?Apollo Hospitals
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT. This problem is confounded by a paucity of high quality evidence in the current literature. This review examines the role of usual biochemical parameters as well as conventional clinical indications for commencing RRT. It also discusses the potential role of biomarkers as predictors for the need of RRT in AKI. Initiating dialysis in AKI should be based on dynamic clinical criteria and not only on specific biochemical values.
This study analyzed data from over 1,400 patients hospitalized for hepatorenal syndrome (HRS) in Japan between 2010-2019 using a national inpatient database. The results showed that 65.5% of patients died or underwent liver transplantation. Patients in this group had more advanced liver disease, were more likely to be male, and had higher rates of complications like hepatocellular carcinoma and spontaneous bacterial peritonitis. Over half of all patients received albumin therapy, while noradrenaline and dopamine were used as vasoconstrictors, with dopamine being more common than noradrenaline in clinical practice despite guidelines recommending noradrenaline. Mortality from HRS in Japan remains high.
This document provides clinical practice guidelines for acute kidney injury (AKI) from the UK Renal Association. It summarizes the definition and staging systems for AKI from ADQI, AKIN and KDIGO to standardize classification. AKI has significant prevalence in hospitalized patients and poor outcomes, with mortality ranging from 10-80% depending on severity and presence of multiorgan failure. Prevention and early recognition of AKI is important. The guidelines cover areas like assessment, prevention, management, renal replacement therapy modalities and prescriptions, and timing of treatment. Improving education of healthcare professionals about AKI is emphasized.
The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study
Extended criteria donors in liver transplantation Part II reviewing the impac...Balázs Nemes
This document reviews the impact of extended-criteria donors on complications and outcomes of liver transplantation. It finds that extended-criteria donors are associated with higher risks of early allograft dysfunction, especially when donors have moderate to severe steatosis. Extended criteria donors also increase the risk of biliary complications and recurrence of hepatitis C virus. However, with new antiviral regimens, sustained virological response can be achieved in most patients. The use of extended criteria donors reduces long-term survival rates, with 1-year survival rates of 87% for low-risk donors and 40% for high-risk donors. Graft survival is excellent for donors up to a certain risk score but declines significantly above that threshold.
Introduction: Chronic Kidney Disease (CKD) is a worldwide public health problem and it is increasing over time. Cardiovascular disease is a major concern for patients with end stage renal disease, especially those on hemodialysis. It is the leading cause of death among patients with chronic kidney
disease, particularly in dialysis population.
This study analyzed transfusion practices over 5 years at SAQR Hospital in Ras Al Khaimah, UAE. A total of 7,045 blood units were transfused, with the highest use in surgical wards (33%), followed by road traffic accident victims (27%). The most common indications for transfusion were injuries from road traffic accidents, orthopedic surgeries, and cardiovascular surgeries. UAE nationals received the most transfusions, and the most common blood group was O positive. The majority of transfused blood products were packed red blood cells. The study concludes that regular assessment of blood usage and education sessions for clinicians could help ensure blood is used effectively for life-threatening situations.
This study assessed the impact of austerity measures in Greece on survival rates of out-of-hospital cardiac arrest victims. Data was collected from a Greek hospital on immediate and 24-hour survival pre-crisis (2007-2010) and during the crisis (2011-2014). Results showed no significant difference in return of spontaneous circulation or 24-hour survival between the two periods, suggesting healthcare workers were working hard to maintain standards despite budget cuts. However, overall survival rates remained low compared to international studies, highlighting the need for more Greek data on cardiac arrests.
This document presents a study on cardiac manifestations and electrocardiographic changes in patients with acute organophosphorus poisoning. The study analyzed hospital records of 100 patients with acute organophosphorus poisoning and found that 90% had tachycardia and 26% had hypertension while 24% had hypotension. Electrocardiograms showed 28% had prolonged QT intervals, 4% had ST changes, and 26% had T wave changes. The study concludes that cardiac complications are common in these patients and require continuous monitoring, even after clinical symptoms improve, as ECG changes can indicate prognosis.
ATC ABSTRACT 2006 - BOS - REVERSIBLE CAUSE OF BRONCHIOLITIS OBLITERANS SYNDR...Yavuz Silay
This study analyzed the impact of bronchial stenosis (BS) on graft function in lung transplant patients. Of the 34 patients studied over 2 years, 57% developed BS. Airway stents were placed in 39% of patients with BS who had a decline in FEV1. Patients with pulmonary fibrosis were more likely to develop BS. Patients who required stents had a more rapid decline in FEV1 than those without airway complications. Early intervention for BS may help slow graft function decline and prevent progression to bronchiolitis obliterans syndrome.
Elevated Tissue Doppler E/E' on Index Admission Can Help Identify Patients at...crimsonpublishersOJCHD
Readmissions for congestive Heart Failure (CHF) are a major healthcare problem that contributes significantly to the overall healthcare expenditure. About 24% of patients are readmitted to the hospital within 30 days of discharge. We investigated whether a non-invasive estimate of left atrial filling pressure, an elevated ratio of early trans mitral flow velocity to early diastolic mitral annular velocity (E/E'), during the index admission for CHF could independently predict 30 day readmission.
Journal of Stem Cell Research and Transplantation is an international, open access, peer reviewed, scholarly journal committed to publish articles in diversified fields of transplantations and applications of stem cell research. The aim of the academic journal is to provide a platform for researchers, scientists, physicians, and other health professionals to find latest research information in the areas of stem cell research, transplantations such as stem cell transplantation, transplantation immunology, kidney transplantation and its treatment. It is a wide-ranging Open Access peer reviewed scientific journal that covers multidisciplinary fields.
Journal of Stem Cell Research and Transplantation accepts original research articles, letter to editor, review articles, mini reviews, case reports, editorials, scientific data, technical reports, rapid communication, and short communications, etc. on all the aspects of stem cells. The Journal of Stem Cell Research and Transplantation publishes latest scientific information, and is generously accessible across the world through internet to go halves the innovations of the researchers for intellectual advancement in this field. Austin also brings universally peer reviewed scientific journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
This study analyzed trends in complications from 2000-2012 using a nationwide database of inpatient therapeutic ERCP procedures in the US. The study found:
1) Mortality rates decreased from 1.77% to 1.24%, and time series analysis confirmed this downward trend.
2) Perforation rates increased from 0.07% to 0.10% but time series analysis found no significant trend.
3) GI hemorrhage rates increased from 1.36% to 1.57% and time series analysis confirmed an upward trend.
The study concluded that while therapeutic ERCPs have become safer as shown by decreasing mortality rates, GI hemorrhage rates increased over the same period according to their analysis of
Access vs non-access site bleeding and risk of subsequent mortality and MACE
This study aimed to analyze the incidence and prognostic impact of access site versus non-access site bleeding in patients undergoing percutaneous coronary intervention (PCI). The meta-analysis included 38 studies and over 520,000 patients. It found that access site bleeding occurred in 11.2% of patients while non-access site bleeding occurred in 10.2% of patients. However, non-access site bleeding was associated with a higher crude mortality rate of 8.3% compared to 2.8% for access site bleeding. Further analyses confirmed that non-access site bleeding carried a greater risk of subsequent mortality and major adverse cardiac events than access site bleeding. The
This document summarizes modern management options for the uraemic syndrome in chronic kidney disease. It discusses the pathophysiology of the uraemic syndrome and how it affects multiple organ systems. Traditional and non-traditional risk factors for cardiovascular disease are examined. Over 150 uraemic retention products have been identified and are divided into small water-soluble compounds, protein-bound compounds, and larger middle molecules. Progression of chronic kidney disease depends on the underlying cause and risk factors, leading to loss of kidney function over time. Management options aim to target modifiable factors like cardiovascular risk simultaneously.
Purpose: To assess the effectiveness of a fast track referral system from Vascular Laboratory to Interventional Radiology on
threatened vein bypass grafts in the lower limbs.
Methods: A Fast Track System (FTS) was set up in February 2011 to minimise the delay from duplex scan to intervention for bypass grafts with identifi ed signifi cant stenoses. 111 scans were performed pre - FTS over one year and compared with 190 scans which were performed post-FTS introduction over two years.
Reversal of warfarin associated coagulopathy prothrombin complex concentratesTÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Raccomandazioni per la valutazione preoperatoria malattie remaliiClaudio Melloni
The document describes a study that developed an Acute Kidney Injury (AKI) risk index for patients undergoing general surgery. The study used data from over 75,000 patients to identify 11 independent preoperative predictors of AKI. These predictors were used to create a risk index with a high predictive capability (c statistic of 0.80). Patients who experienced AKI had an eightfold increase in 30-day mortality. The risk index can help identify patients at risk of AKI so preventative measures or closer monitoring can be taken.
This document discusses statistics related to heart failure. It summarizes data on outcomes for hospitalized heart failure patients compared to chronic heart failure patients. Hospitalized patients generally have worse outcomes, with high 1-year mortality rates around 25-27%. Chronic heart failure patients have lower but still significant 1-year mortality rates of around 5-6%. The document also reviews real-world data showing high readmission rates after hospitalization for heart failure. It concludes that while treatments for chronic heart failure with reduced ejection fraction have improved outcomes over decades, more efforts are still needed to improve care and outcomes for hospitalized patients and those with preserved ejection fraction.
2. continuous renal replacement therapy recent advances and future researchEdleo13
The document summarizes two large randomized controlled trials that provide new evidence to guide clinicians on the use of continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) in intensive care units (ICUs). The ATN and RENAL trials investigated different intensities of CRRT and found that effluent flow rates above 25 ml/kg per hour do not improve outcomes. The trials also established CRRT as the most appropriate treatment for vasopressor-dependent AKI patients in the ICU. However, questions remain regarding optimal initiation thresholds and timing of CRRT.
When to Initiate RRT in Patients with AKI - Does Timing Matter?Apollo Hospitals
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT.
When to initiate RRT in patients with AKI - Does timing matter?Apollo Hospitals
When to initiate RRT in patients with AKI remains an area of debate due to lack of consensus on the optimal timing. The document reviews evidence on using various biochemical parameters and clinical indicators to guide RRT initiation. Studies have shown conflicting results for triggers like serum creatinine, urea, and oliguria. Earlier initiation of RRT may improve outcomes by preventing fluid overload, though high-quality randomized trials are still needed to definitively establish best practices. The cause of AKI and individual patient factors are also important considerations in determining optimal timing.
When to Initiate RRT in Patients with AKI - Does Timing Matter?Apollo Hospitals
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT. This problem is confounded by a paucity of high quality evidence in the current literature. This review examines the role of usual biochemical parameters as well as conventional clinical indications for commencing RRT. It also discusses the potential role of biomarkers as predictors for the need of RRT in AKI. Initiating dialysis in AKI should be based on dynamic clinical criteria and not only on specific biochemical values.
This study analyzed data from over 1,400 patients hospitalized for hepatorenal syndrome (HRS) in Japan between 2010-2019 using a national inpatient database. The results showed that 65.5% of patients died or underwent liver transplantation. Patients in this group had more advanced liver disease, were more likely to be male, and had higher rates of complications like hepatocellular carcinoma and spontaneous bacterial peritonitis. Over half of all patients received albumin therapy, while noradrenaline and dopamine were used as vasoconstrictors, with dopamine being more common than noradrenaline in clinical practice despite guidelines recommending noradrenaline. Mortality from HRS in Japan remains high.
This document provides clinical practice guidelines for acute kidney injury (AKI) from the UK Renal Association. It summarizes the definition and staging systems for AKI from ADQI, AKIN and KDIGO to standardize classification. AKI has significant prevalence in hospitalized patients and poor outcomes, with mortality ranging from 10-80% depending on severity and presence of multiorgan failure. Prevention and early recognition of AKI is important. The guidelines cover areas like assessment, prevention, management, renal replacement therapy modalities and prescriptions, and timing of treatment. Improving education of healthcare professionals about AKI is emphasized.
The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study
This document provides clinical practice guidelines for the management of Acute Kidney Injury (AKI). It discusses the definition and staging systems for AKI, epidemiology and outcomes. Prevention, management, treatment facilities and timing of renal replacement therapy are covered. Guidelines are provided on choice of renal replacement modality, dialyser membranes, vascular access, anticoagulation, and prescription of renal replacement therapy. There is a lack of evidence to guide optimal care and timing of renal replacement therapy. The document aims to standardize care and improve outcomes of patients with AKI.
Clinical eHealth 3 (2020) 40–48Contents lists available at SWilheminaRossi174
Clinical eHealth 3 (2020) 40–48
Contents lists available at ScienceDirect
Clinical eHealth
journal homepage: ww.keaipublishing.com/CEH
Long-term effects of telemonitoring on healthcare usage in patients with
heart failure or COPD q
https://doi.org/10.1016/j.ceh.2020.05.001
2588-9141/� 2020 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
q In collaboration with the Slingeland Hospital in Doetinchem, The Netherlands,
and Stichting Sensire in Varsseveld (‘InBeeld’ program), The Netherlands.
⇑ Corresponding author.
E-mail address: [email protected] (J.M.M. van der Burg).
Jorien M.M. van der Burg a,⇑, N. Ahmad Aziz b,c, Maurits C. Kaptein d, Martine J.M. Breteler e,f,
Joris H. Janssen e, Lisa van Vliet a, Daniel Winkeler g, Anneke van Anken h, Marise J. Kasteleyn a,i,
Niels H. Chavannes a
a Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
b Department of Neurology, University of Bonn, Bonn, Germany
c Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
d Jheronimus Academy of Data Science, Den Bosch, The Netherlands & Department of Statistics and Research Methods, Tilburg University, Tilburg, The Netherlands
e FocusCura, Driebergen-Rijssenburg, The Netherlands
f Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
g Room To, De Meern, The Netherlands
h Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
i Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
a r t i c l e i n f o
Article history:
Received 5 November 2019
Revised 29 April 2020
Available online 20 May 2020
Keywords:
Heart failure
Chronic Obstructive Pulmonary Disease
(COPD)
Telemonitoring
Remote patient monitoring (RPM)
Home monitoring
Home telemonitoring
Telemedicine
eHealth
a b s t r a c t
Background: Heart failure and chronic obstructive pulmonary disease (COPD) are leading causes of dis-
ability and lead to substantial healthcare costs. The aim of this study was to evaluate the effectiveness
of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or COPD.
Methods: The study was a retrospective observational study with a follow-up duration of up to 3 years in
which for all participants data before and after enrollment in the telemonitoring program was compared.
Hundred seventy-seven patients with heart failure (NYHA functional class 3 or 4) and 83 patients with
COPD (GOLD stage 3 or 4) enrolled in a home telemonitoring program in addition to receiving usual hos-
pital care. The primary outcome was the number of hospitalizations; the secondary outcomes were total
number of hospitalization days and healthcare costs during the follow-up period. Generalized Estimating
Equations w ...
This document provides a summary of the November 2014 issue of the UTSW Internal Medicine Journal Watch. It includes summaries of articles on topics such as assessing acid-base disturbances, managing Staphylococcus aureus bacteremia, community acquired pneumonia, predicting hepatocellular carcinoma in hepatitis C patients, and guidelines for prioritizing patients for new hepatitis C treatments. It also reviews articles related to infectious diseases, critical care, nephrology, cardiology, and more.
Acute kidney injury from diagnosis to prevention and treatment strategiesLeonardo Rodrigues
- Acute kidney injury (AKI) is characterized by a rapid decline in kidney function and is associated with increased short and long-term mortality. AKI diagnosis relies on changes in serum creatinine and urine output.
- Risk factors for AKI include older age, chronic kidney disease, comorbidities like diabetes and heart disease, as well as exposures to sepsis, surgery, nephrotoxins and shock. Causes of AKI include pre-renal, intrinsic renal and post-renal factors.
- Prevention strategies focus on identifying at-risk patients, optimizing volume status, and discontinuing or avoiding nephrotoxins. Treatment involves correcting hypovolemia, discontinuing
Morbidity and Mortality are Not Improved by Preemptive ICU Transfer of Acute ...semualkaira
Acute myeloid leukemia (AML) is associated
with a high rate of life-threatening early complications. Patients
presenting with hyperleukocytosis >50x10⁹/L and/or promyelocytic leukemia at the time of AML diagnosis can be considered at
high risk of early complications (HReC) and thus at high risk of
mortality. At our institution, we propose preemptive ICU admission to HReC patients. In so doing, our goal is to prevent complication occurrence, or, failing that, to provide rapid life-sustaining
treatment (LST). In the present retrospective study, we sought to
determine whether preemptive ICU admission improves survival
for patients newly diagnosed with AML.
Assessment Outcomes Dyslipidaemia in Dialysis PatientAI Publications
Background: Chronic kidney disease is defined as the presence, for more than three months, of changes in the structure or function of the kidneys, secondary to a progressive decline in the number of nephrons, with a consequent deterioration in health resulting from the inability of the kidneys to perform their excretory functions, softener, and metabolism. Chronic kidney disease (CKD) is a clinical condition caused by the progressive and progressive loss of kidney function. Chronic kidney disease is not only implicated by the gradual deterioration of quality of life and life expectancy when it progresses to more advanced stages but also by the increase in cardiovascular morbidity and mortality, which is the leading cause of death in these patients. Aim: This paper aims to assess the outcomes of dyslipidemia in a dialysis patient. Patients and method: In this study, a descriptive cross-sectional study was applied to study the Assessment Outcomes of Dyslipidemia in Dialysis Patients in Iraq from 4th January 2021 to 7th August 2022. Data were collected for 150 patients in different hospitals in Iraq, where the patients were divided into two groups, the first group of patients, which included DIALYSIS PATIENTS, which included 80, and the second group, the control group, which included patients, which include 70 patients. Results and discussions: collected 150 cases distributed according to dialysis patients (80) and controls (70); the most frequent ages in this study ranged from 40-49 years old 34 (42.5%) patients group, 33 (47.14%) control group with a statistical difference of 0.0831. In this study was evaluated the Outcomes of dyslipidemia in a dialysis patient. Imbalances were found in levels of dyslipidemia which LDL 5.12±3.4 of the patients' group, as for the control group 2.1±3.3-HDL 2.43±2.4 of the patients' group, 1.4±1.5 for the control group, TRIGLYCERIDE 1.75±1.8 of patients group, 0.55±0.43 for the control group with A statistically significant relationship were found between dyslipidemia levels and outcomes in the group of patients at P value < 0.05.
Evaluate of the Physical Performance of Patients Undergoing HemodialysisAhmed Alkhaqani
This study aimed to measure the physical performance of 62 patients undergoing hemodialysis using the Short Physical Performance Battery (SPPB) scale. The study found that the patients' physical performance was below predicted levels at baseline and deteriorated further over three assessments spaced four weeks apart. The results indicated poor physical performance in patients with chronic kidney disease undergoing hemodialysis. This was related to low physical activity levels in this patient population rather than demographic or clinical factors.
Peritoneal dialysis (PD) is associated with better preservation of residual kidney function compared to hemodialysis (HD). PD also has advantages such as lower infection risks and improved quality of life through increased employment rates and lifestyle flexibility compared to HD. However, PD remains underutilized in many countries despite its benefits. Factors contributing to underutilization include modality preferences of nephrologists, lack of patient education, and system-related barriers. Integrated care approaches emphasizing early referral and shared modality decision-making between patients and nephrologists are optimal for end-stage renal disease treatment.
Les comparto la publicación del estudio Xatoa
Nosotros en la Clínica de Mérida participamos como investigadores en el reclutamiento y análisis de datos de los pacientes de nuestra consulta diaria quienes han recibido el beneficio de la Terapia de Inhibición de Doble Vía.
Es un gusto enorme contribuir al desarrollo del conocimiento médico global 🌎
This study examined 10-year outcomes of 600 patients with unprotected left main coronary artery disease randomized to percutaneous coronary intervention (PCI) with sirolimus-eluting stents or coronary artery bypass grafting (CABG). At 10 years, the primary outcome of major adverse cardiac or cerebrovascular events occurred in 29.8% of the PCI group and 24.7% of the CABG group, with no significant difference. Similarly, there were no significant differences in the composite of death, myocardial infarction or stroke, or all-cause mortality between groups. However, ischemia-driven target vessel revascularization was 8% higher with PCI. This long-term study found no difference in major clinical outcomes between PCI and
Surgery or Endovascular Treatment, which is the Better Way to Treat Acute and...semualkaira
To investigate the influence of surgical and endovascular treatment on the prognosis of acute and chronic mesenteric ischemia and to further evaluate whether endovascular
treatment can reduce postoperative complications by performing
a meta-analysis.
Surgery or Endovascular Treatment, which is the Better Way to Treat Acute and...semualkaira
To investigate the influence of surgical and endovascular treatment on the prognosis of acute and chronic mesenteric ischemia and to further evaluate whether endovascular
treatment can reduce postoperative complications by performing
a meta-analysis.
Surgery or Endovascular Treatment, which is the Better Way to Treat Acute and...semualkaira
To investigate the influence of surgical and endovascular treatment on the prognosis of acute and chronic mesenteric ischemia and to further evaluate whether endovascular treatment can reduce postoperative complications by performing a meta-analysis.
Chronic kidney disease (CKD) is a global public health problem
worldwide. The worldwide prevalence of CKD has increased in
various countries such as the U.S. (13.1%), Taiwan (9.8-11.9%),
Norway (10.2%), Japan (12.9-15.1%) China (3.2-11.3%), Korea (7.2- 13.7%), Thailand (8.45-16.3%), Singapore (3.2-18.6%), and Australia(11.2%)
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
Visit : https://massagespaajman.com/
Call : 052 987 1315
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
Tips for Pet Care in winters How to take care of pets.
De corteetal2016
1. See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/306085594
Long-term outcome in ICU patients with acute kidney injury treated with
renal replacement therapy: A prospective cohort study
Article in Critical care (London, England) · December 2016
DOI: 10.1186/s13054-016-1409-z
CITATIONS
66
READS
236
9 authors, including:
Some of the authors of this publication are also working on these related projects:
Critical Care Nutrition View project
Care pathways for donation after brain death: www.CP4DBD.be View project
Wouter De Corte
AZ Groeninge
17 PUBLICATIONS 255 CITATIONS
SEE PROFILE
Raymond Vanholder
Ghent University
510 PUBLICATIONS 29,540 CITATIONS
SEE PROFILE
Jan J De Waele
Ghent University
785 PUBLICATIONS 20,515 CITATIONS
SEE PROFILE
Stefaan Claus
Universitair Ziekenhuis Ghent
21 PUBLICATIONS 338 CITATIONS
SEE PROFILE
All content following this page was uploaded by Eric Hoste on 30 August 2016.
The user has requested enhancement of the downloaded file.
3. Background
Acute kidney injury (AKI) is a frequent finding in inten-
sive care unit (ICU) patients, with a prevalence of ap-
proximately 40–57 % when defined according to the
Kidney Disease: Improving Global Outcomes (KDIGO)
criteria. AKI treated with renal replacement therapy
(AKI-RRT) occurs in approximately 13 % of ICU pa-
tients [1, 2]. It is associated with adverse outcomes such
as increased length of stay, short- and long-term mortal-
ity, and end-stage renal disease (ESRD). In the past, AKI
was considered a surrogate marker for severity of illness,
and patient mortality was considered a consequence of
the underlying disease [3]. However, there is an abun-
dance of epidemiological data demonstrating that AKI in
itself leads to adverse outcomes. This is so for the most
severe form of AKI, where patients are treated with RRT
[4, 5]. In addition, small decreases in kidney function are
associated with increased short-term mortality. Further,
the prevalence of preexisting chronic kidney disease
(CKD) is increasing among patients admitted to the
ICU. CKD may lower the threshold for developing AKI,
and acute-on-chronic kidney disease is associated with
adverse outcomes [3–7]. Further, even mild AKI may
predispose patients to CKD, and thus it increases the
risk of subsequent AKI events and finally ESRD [8–10].
So, AKI can be considered both the cause and the con-
sequence of CKD, and AKI and CKD therefore are con-
sidered interconnected and integrated syndromes [6].
The association of CKD with mortality remains a mat-
ter of debate. On one hand, a recent large registry study
demonstrated an association of CKD and death [7]. On
the other hand, critically ill patients with AKI-RRT who
had CKD were reported to have lower short-term mor-
tality than those without preexisting CKD [9, 11–14].
Another factor that may impact long-term outcomes is
modality of RRT. Observational studies suggest that con-
tinuous RRT (CRRT) is associated with better kidney
outcomes, more specifically with less need for chronic
dialysis [8, 9]. However, prospective randomized studies
could not demonstrate a survival benefit of CRRT com-
pared with intermittent therapies [10, 11]. Finally, opti-
mal timing of initiation of RRT is unclear. RRT is
initiated early in the absence of serious complications of
AKI and may therefore have some advantages. The late
and more conservative approach takes into account that
some patients with severe AKI might recover kidney
function spontaneously without starting RRT, thereby
avoiding adverse events linked to RRT [12].
Until recently, studies of AKI in ICU patients were fo-
cused on conventionally accepted short-term outcomes
such as mortality at day 30 or at ICU and hospital dis-
charge. However, these endpoints may underestimate
the true burden of kidney disease. In light of the increas-
ing focus on long-term outcomes, researchers in several
studies have investigated the links between AKI, CKD,
and ESRD [13, 14]. By way of analogy to major adverse
cardiovascular events, this led to the introduction of the
composite endpoint major adverse kidney events
(MAKE) [15]. MAKE is a composite of death, ESRD
needing dialysis, and incomplete kidney recovery, de-
fined as a 25 % decrease of estimated glomerular filtra-
tion rate (eGFR), measured at long-term endpoints such
as 90 days or 1 year. The aim of the present study was
to describe long-term patient and kidney outcomes in a
cohort of patients with AKI-RRT and to assess possible
modifying factors of outcome, such as CKD, timing of
initiation of RRT, and RRT modality.
Methods
We conducted a single-center prospective cohort analysis
of patients with AKI-RRT at the ICU of the Ghent Univer-
sity Hospital over an 8-year period (October 2004–October
2012). The Ghent University Hospital ICU consists of a
22-bed surgical ICU, a 14-bed medical ICU, an 8-bed
cardiac surgery ICU, and a 6-bed burn ICU.
Study cohort
The inclusion criteria were ICU patients aged ≥15 years
who had AKI and were treated with RRT and who had
follow-up data after hospital discharge. During the study
period, an electronic patient data management system
(PDMS) was gradually introduced. Only patients who
were registered in the PDMS were included in the study
[16]. Exclusion criteria were extracorporeal blood purifi-
cation techniques for reasons other than AKI, patients
with CKD receiving chronic RRT, RRT initiated before
admission to the ICU, and RRT immediately after kidney
transplant. In cases where a patient had several ICU epi-
sodes of AKI-RRT during the same hospital admission,
we considered only the first episode.
Indications for RRT, as well as the modality chosen
(i.e., intermittent hemodialysis [IHD], duration 2–4 h
per treatment session; slow extended daily dialysis
[SLEDD], duration 6–12 h per treatment session; or
CRRT [continuous venovenous hemofiltration or
hemodialysis]), were determined by consensus between
the attending intensivists and nephrologists and based on
the clinical status of the patient (fluid balance, respiratory
status, acid-base balance). Continuous modalities are pref-
erentially used in patients with severe shock, patients who
are at risk for cerebral edema (e.g., liver cirrhosis), or
patients for whom fluid removal is pursued [17].
Definitions
Reference serum creatinine was either a baseline serum
creatinine concentration obtained from the laboratory
database within a 12-month period prior to hospital ad-
mission or, if unavailable, serum creatinine at the time of
De Corte et al. Critical Care (2016) 20:256 Page 2 of 13
4. hospital admission. In the latter group, some patients
already had AKI at the time of hospital admission.
Therefore, in the group for which we had to rely on hos-
pital admission creatinine, we excluded patients who
were initiated on RRT within 2 days after hospital
admission, as well as patients who had a higher serum
creatinine concentration at the time of admission than
at hospital discharge. We did not apply back-calculation
of baseline serum creatinine with the Modification of
Diet in Renal Disease eGFR formula as suggested by the
KDIGO AKI guidelines, because this would have led to
underestimation of the number of patients with preexist-
ing CKD stage 3 or higher [18].
Timing of initiation of RRT was defined using the
KDIGO staging criteria. Initiation of RRT at KDIGO
stage 1 or 2 was defined as “early,” and initiation of RRT
at KDIGO stage 3 was defined as “late.” Oliguria was de-
fined as diuresis of less than 500 ml over 24 h preceding
the initiation of RRT. Fluid balance comprising the 24-h
episode before initiation of RRT was calculated by the
PDMS. Recovery of kidney function was assessed only in
patients with reference creatinine. Recovery of kidney
function was classified as complete when eGFR was
within 25 % of the reference eGFR (based on reference
serum creatinine). Incomplete kidney recovery was de-
fined as patients who had a 25 % or greater decline of
reference eGFR and who were not treated with dialysis.
Absent kidney recovery was defined as the permanent
need for RRT for more than 3 months. Since long-term
serum creatinine data were seldom available at the exact
follow-up times (e.g., 90 days), we allowed the following
intervals: day 90 ± 7 days, 1 year ± 60 days, 2 year ±
60 days, and 3 years ± 60 days.
CKD was defined according to eGFR categories per
the KDIGO criteria [19]: Stage 1 CKD is an eGFR
>90 ml/minute/1.73 m2
; stage 2 is 60–90 ml/minute/
1.73 m2
; stage 3 is 30–60 ml/minute/1.73 m2
; stage 4 is
15–30 ml/minute/1.73 m2
; and stage 5 is <15 ml/mi-
nute/1.73 m2
or chronic RRT (hemodialysis or peritoneal
dialysis). Patients with CKD stage 3 or worse were classi-
fied for the purposes of this study as patients with CKD
and compared with patients who had CKD stage 2 or
less (no CKD) [15]. Late initiation of RRT was defined
as initiation of RRT at KDIGO stage 3. The MAKE com-
posite endpoint was assessed in the patient cohort with
reference creatinine, and it was defined as the presence
of one or more of the following: death, incomplete
kidney recovery, and/or development of ESRD treated
with RRT [15].
Study outcomes
The primary outcome measure of the study was mortal-
ity 1 year after initiation of RRT. The secondary out-
comes were long-term patient survival and long-term
kidney function measured as kidney recovery and dialy-
sis dependence in hospital survivors. In addition, we re-
ported and evaluated the composite outcome measure
MAKE. We eventually assessed the classical determi-
nants of long-term outcome of AKI treated with RRT:
preexisting CKD, timing of initiation of RRT, and RRT
modality.
Data collection
Data were prospectively recorded during the hospital
stay. Baseline demographic parameters were retrieved
from the hospital’s electronic database and the ICU’s
electronic PDMS. Data on comorbidity and diagnostic
categories were retrieved from the hospital administra-
tion’s International Classification of Diseases, Ninth Re-
vision, electronic coding system. The severity of illness
as determined by the Simplified Acute Physiology Score
II (SAPS II) score (based on data recorded during the
first 24-h of ICU admission) was recorded at the time of
ICU admission [20, 21]. At the time of initiation of RRT,
severity of illness was assessed on the basis of parame-
ters of organ dysfunction and Sepsis-related Organ Fail-
ure Assessment (SOFA) score [22]. Kidney laboratory
data were recorded at hospital admission; ICU admis-
sion; initiation of RRT; hospital discharge; and 30 and
90 days and 1, 2, and 3 years. Data on long-term follow-
up were gathered from the patients’ electronic medical
records (e.g., during follow-up consultation or, in cases
of absence of such a consultation, by contacting the
primary care physician of the patient by e-mail or
telephone).
Statistical analysis
The data are expressed as number (proportion), median
(interquartile range), or OR (95 % CI). Univariate analyses
of long-term mortality and MAKE were performed with
the Mann-Whitney U test, Fisher’s exact test, Friedman’s
two-way analysis of variance by ranks test, Wilcoxon
rank-sum test, Kruskal-Wallis test, and chi-square test, as
appropriate. The predictors thus obtained were subse-
quently tested in a multivariable logistic regression model.
Variables selected for inclusion in the regression model
were those with a plausible rationale, with a P value ≤0.25
in bivariate analysis. Significant covariates for MAKE were
identified after constructing a model in which all covari-
ates were entered simultaneously (enter method). We ana-
lyzed for colinearity by assessing correlations between
covariates; in addition, interaction was explored. Goodness
of fit was assessed according to the method described by
Hosmer and Lemeshow. Statistical significance was ac-
cepted when the P value was <0.05.
The event-free survival rate was estimated using the
Kaplan-Meier method, and significance was evaluated
with the log-rank test. A Cox proportional hazards
De Corte et al. Critical Care (2016) 20:256 Page 3 of 13
5. model was developed to address the predictors of long-
term survival. These analyses were performed with use
of IBM SPSS Statistics for Windows, version 23.0.0
(IBM, Armonk, NY, USA).
Results
During the 8-year study period, 23,665 first ICU admis-
sions were registered. A total of 1292 patients (5.5 %)
had AKI-RRT, and 959 patients were included in the
final analyses (Fig. 1). Of these, 609 patients (63.4 %)
had a reference creatinine level documented. Demo-
graphic data of the study cohort are shown in Table 1.
Patient outcome and long-term survival
ICU mortality was 54.6 %. Mortality increased from
59.7 % at the time of hospital discharge to 64.5 % at
1 year, 67.9 % at 2 years, and 72.1 % at 3 years (Fig. 2a).
Among hospital survivors, 11.9 % later died at 1 year,
19.3 % at 2 years, and 27.2 % at 3 years (Fig. 2b).
One-year nonsurvivors were significantly older than
survivors but had less CKD. A greater proportion of
nonsurvivors were female and had been admitted to the
medical ICU. At ICU admission, nonsurivors’ severity of
illness based on their SAPS II scores were than those of
survivors. At initiation of RRT, nonsurvivors had higher
SOFA scores than survivors. Their hemodynamic status
was more unstable, as a greater proportion were treated
with vasoactive agents, had a positive fluid balance, were
more acidotic, and had higher serum lactate and more
negative base excess. Nonsurvivors were less often
treated with diuretics, and a greater proportion were
mechanically ventilated and treated with CRRT as the
initial RRT modality (Table 1). Patients treated with
CRRT as the initial RRT modality had worse survival
than patients treated with IHD (P < 0.001 by log-rank
test) (Fig. 2c).
We found that, after adjustment for confounders in a
Cox proportional hazards model, CRRT as the initial
RRT modality was associated with long-term mortality
(HR 1.570, 95 % CI 1.202–2.050, P = 0.001). Baseline kid-
ney function and timing of RRT were not associated with
survival in this model. Other confounders associated with
survival were older age and increased severity of illness
(full model provided in Additional file 1: Table S1).
Kidney outcomes
Nephrology consultation after hospital discharge was re-
ported in only 34.0 % of hospital survivors. Nephrology
follow-up was more frequent in patients with CKD stage
≥3 compared with patients with CKD stage <3 (51.0 %
versus 31.8 %, P = 0.003). Among hospital survivors, dia-
lysis dependence rates were 8.6 % at hospital discharge,
9.0 % at 90 days, 14.1 % at 1 year, 14.0 % at 2 years, and
16.9 % at 3 years.
In order to assess kidney outcomes with a focus on
(in)complete renal recovery, the cohort of hospital survi-
vors who had a reference creatinine value was studied
(Table 2). In these patients, we found that after 1 year of
follow-up, 48.4 % had complete recovery of kidney func-
tion, 32.6 % had incomplete recovery, and 19.0 % had
ESRD and were being treated with chronic dialysis. Pa-
tients who had incomplete recovery had better kidney
function and less often had diabetes before AKI. Patients
receiving chronic dialysis treatment more often had dia-
betes, CKD, and oliguria at the time of initiation of RRT.
The evolution of kidney outcomes over time are summa-
rized in Fig. 3. Complete renal recovery peaked at 90 days
(56.7 %) and further decreased over time. Dialysis de-
pendence increased over time from 13.8 % at hospital
discharge to 28.1 % at 3 years. Patients who had prior
CKD had more ESRD treated with dialysis than patients
without CKD, but they had less incomplete renal recov-
ery (without need for RRT) (Table 3).
MAKE
Over time, MAKE increased in the total cohort; it was
present in 83.1 % of the patients at hospital discharge,
86.0 % at 90 days, 87.5 % at one year and 92.4 % and
93.7 % at two and three years respectively. MAKE was
mainly determined by mortality (Fig. 4). MAKE was
more frequent in patients with prior CKD stage <3
compared with patients with preexisting CKD stage ≥3
(Table 3).
Fig. 1 Study flowchart. PDMS patient data management system,
AKI acute kidney injury, ICU intensive care unit, RRT renal
replacement therapy
De Corte et al. Critical Care (2016) 20:256 Page 4 of 13
8. Variables associated with MAKE at 1 year
In univariate analysis, variables associated with MAKE
at 1 year were the absence of preexisting CKD, severity
of illness on ICU admission and at initiation of RRT
(based on SAPS II and SOFA scores, mechanical ventila-
tion, hemodynamic instability with need for vasoactive
medication anemia, low platelet count, acidosis, and
hyperlactatemia), oliguria, serum creatinine level, and
CRRT modality at initiation of RRT (Table 1). On the
basis of this univariate analysis, we analyzed associations
in a multivariate logistic regression model. After adjust-
ment for confounding covariates, we found that preexist-
ing kidney disease, initial RRT modality, and timing of
initiation of RRT were not associated with MAKE at 1 year
(full model provided in Additional file 1: Table S2).
Discussion
We conducted an 8-year analysis of more than 23,000
first ICU admissions and found that AKI-RRT occurred
in 5.5 % of patients admitted to the ICU. Mortality rates
were high, with almost 60 % of the patients dying during
their hospital stay and approximately an additional 10 %
per year of the hospital survivors in the years following
discharge. Apart from advancing age and increased se-
verity of illness, CRRT as the initial RRT modality was
associated with long-term mortality. As for kidney out-
comes, almost one-fifth of the AKI-RRT hospital survi-
vors had ESRD at 1 year. Kidney recovery in hospital
survivors after AKI-RRT was determined by preexisting
renal comorbidity and diabetes mellitus. Finally, after
adjustment for covariates, the occurrence of MAKE was
not associated with preexisting CKD, timing of initiation
of RRT, or RRT modality.
The occurrence rate and mortality of our cohort are
concordant with data reported by units in other devel-
oped countries [2, 23, 24]. Similarly to other studies, and
not surprisingly, long-term mortality was associated with
not only advanced age but also variables depicting sever-
ity of illness and accompanying hemodynamic instability:
use of mechanical ventilation, vasoactive agents, and a
positive fluid balance. The association of CRRT as the
initial modality of RRT with long-term mortality fits in
this concept. In our unit, all modalities are used, and
CRRT is used as the initial modality in patients who are
in severe shock or for whom slow fluid removal is war-
ranted. When a patient’s condition improves, the modal-
ity is switched to SLEDD or IHD. In other words, the
choice of the initial modality may serve as a surrogate
for severity of illness. Our findings are similar to those
of a recent study where RRT modality was also chosen
Fig. 2 a Kaplan-Meier survival curve over time for the whole cohort. b Kaplan-Meier survival curve over time for hospital survivors. c Kaplan-Meier
survival curve stratified for continuous renal replacement therapy (CRRT) modality (P < 0.001 by log-rank test), intermittent hemodialysis (IHD), and
slow extended daily dialysis (SLEDD)
De Corte et al. Critical Care (2016) 20:256 Page 7 of 13
10. on the basis of the hemodynamic status of the patient
[25], but they are in contrast to those in other cohort
studies [8, 10, 26, 27]. The recently published studies on
timing of RRT by Wald et al, as well as the ELAIN and
Artificial Kidney Initiation in Kidney Injury (AKIKI)
studies, also illustrate the complexity of the impact of
timing on outcomes. While two of these studies could
demonstrate no effect of timing, the ELAIN study
showed a marked survival benefit for early initiation.
Differences between these studies were the definition of
early and late initiation, as well as the patients’ charac-
teristics (surgical versus general ICU), modalities used
(CRRT in ELAIN versus all modalities in the other stud-
ies), and single-center observation (ELAIN) versus mul-
ticenter studies (Wald and AKIKI) [28–30].
We found that, among 1-year survivors with known
reference serum creatinine values, only 50 % had
complete recovery of kidney function. With a dialysis
dependence rate of 9.0 % in survivors at day 90, our
findings were lower than those reported in the Finnish
Acute Kidney Injury (FINNAKI) study (18.9 % at 90 days)
and higher than in the Randomized Evaluation of
Normal versus Augmented Level Replacement Therapy
(RENAL) study (5.6 % at 90 days) and the IVOIRE study
(1.4 %) [2, 23, 31]. The FINNAKI, RENAL, and IVOIRE
trials used CRRT only, while we started CRRT in only
one-fifth of patients.
Interestingly, as dialysis dependence was associated
predominantly with comorbidities such as diabetes and
CKD, patients with acute-on-chronic kidney disease face
a significant risk of developing ESRD. This is similar
to findings in other cohort studies and meta-analyses
[7, 25, 32, 33].
As many as one-third of patients in our cohort had in-
complete renal recovery. Follow-up of patients in the
RENAL study also revealed that a large proportion of
AKI-RRT survivors had albuminuria and decreased
eGFR [34]. Close follow-up and interventions aimed at
preserving kidney function may positively impact long-
term outcomes. Similar to data reported in the United
States [35], only 34.0 % of AKI-RRT survivors in our co-
hort had follow-up of kidney function by a nephrologist.
In our hospital, follow-up by a nephrologist is not
protocol-driven but depends on the clinical and renal
status of the patient. So, how this possibly impacted
kidney outcome and survival is not clear. Especially in
patients with acute-on-chronic kidney disease, more
Table 2 Renal recovery (complete and incomplete) versus dialysis dependence at 1 year in patients with reference serum creatinine
values (Continued)
Base excess −4.0 (−6.6, −1.6) −4.6 (−6.5, −2.9) −4.5 (−7.3, −3.3) 0.628
RRT modality
IHD, % 73.0 68.3 74.3 0.799
SLEDD, % 14.6 16.7 8.6
CRRT, % 12.4 15.0 17.1
Timing of initiation of RRTa
Early, % 46.1 35.0 50.0 0.309
Late, % 53.9 65.0 50.0
Abbreviations: APACHE II Acute Physiology and Chronic Evaluation II, CKD chronic kidney disease, CRRT continuous renal replacement therapy, eGFR estimated
glomerular filtration rate, ICU intensive care unit, IHD intermittent hemodialysis, IQR interquartile range, KDIGO Kidney Disease: Improving Global Outcomes, RRT
renal replacement therapy, SAPS II Simplified Acute Physiology Score II, SLEDD slow extended daily dialysis, SOFA Sepsis-related Organ Failure Assessment
a
Early (KDIGO stage <3 at initiation RRT), late (KDIGO stage ≥3 at initiation of RRT
Statistically significant data (P<0.05) are presented in bolditalic
Fig. 3 Renal recovery was defined as complete when estimated
glomerular filtration rate (eGFR) was within 25 % of baseline eGFR.
Incomplete kidney recovery was defined as those patients with an
eGFR decrease of 25 % or more from baseline eGFR without need
for dialysis. Dialysis dependence was defined as end-stage renal
disease and permanent need for renal replacement therapy
for >3 months
De Corte et al. Critical Care (2016) 20:256 Page 9 of 13
11. standardized kidney follow-up by a general practitioner
or nephrologist may be appropriate.
After adjustment for covariates, MAKE was not associ-
ated with the classic determinants of outcome, such as
preexisting CKD, timing of RRT, or modality of RRT. Our
results demonstrate the benefits and limitations of the use
of MAKE as a composite endpoint in AKI studies. MAKE
is a clearly defined and clinically important endpoint.
Compared with single-outcome endpoints, it captures a
greater proportion of patients with poor long-term
outcomes, turning MAKE into a relevant endpoint.
However, detailed evaluation of this outcome parameter
necessitates the presentation of the individual components
[15, 36–39]. In this study, MAKE was determined mainly
by variables associated with its biggest individual compo-
nent, mortality. Not surprisingly, variables associated with
mortality in univariate analysis were also associated with
MAKE: increased severity of illness scores and mechanical
ventilation but also the presence of hemodynamic instabil-
ity at initiation of RRT, depicted by the use of vasoactive
medication, hyperlactatemia, acidosis, and a positive fluid
balance.
This study has several strengths. First, it describes an
up to 8-year follow-up period in a large cohort of pa-
tients with a heavy burden of disease. Second, apart from
the classical mortality rates, we also report detailed in-
formation concerning possible determinants of outcome
in ICU patients with AKI treated with RRT, such as
preexisting CKD, timing of initiation of RRT, and initial
modality of RRT. Further, (in)complete renal recovery
and dialysis dependence are extensively described. By
emphasizing the risk of development of ESRD not only
Table 3 Renal recovery and development of end-stage renal disease in patients with acute-on-chronic kidney disease versus patients
without preexisting chronic kidney disease (subgroup analysis in patients with known reference baseline serum creatinine concentration)
Kidney outcome Total Preexisting CKD KDIGO stage <3 Preexisting CKD KDIGO stage ≥3 P value
Hospital discharge
Complete renal recovery, % 47.8 47.2 51.3 0.055
Incomplete renal recovery, % 38.4 45.7 32.3
Dialysis dependence, % 13.8 7.1 14.6
90 days
Complete renal recovery, % 56.7 55.8 65.2 0.010
Incomplete renal recovery, % 28.1 34.6 15.2
Dialysis dependence, % 15.2 9.6 19.7
1 year
Complete renal recovery, % 48.4 47.4 57.1 0.001
Incomplete renal recovery, % 32.6 45.3 22.1
Dialysis dependence, % 19.0 7.4 20.8
2 years
Complete renal recovery, % 41.5 34.7 57.1 <0.001
Incomplete renal recovery, % 39.5 61.1 22.2
Dialysis dependence, % 19.0 4.2 20.6
3 years
Complete renal recovery, % 39.8 39.1 51.0 <0.001
Incomplete renal recovery, % 32.0 51.6 15.7
Dialysis dependence, % 28.1 9.4 33.3
MAKE
Hospital discharge, % 83.1 87.3 51.0 <0.001
90 days, % 86.0 81.9 78.2 0.280
1 year, % 87.5 87.4 79.4 0.010
2 years, % 92.4 92.4 84.2 0.002
3 years, % 93.7 92.4 88.5 0.124
Abbreviations: CKD chronic kidney disease, KDIGO Kidney Disease: Improving Global Outcomes, MAKE major adverse kidney events
Renal recovery was defined as complete when estimated glomerular filtration rate (eGFR) was within 25 % of baseline eGFR. Incomplete kidney recovery was
defined as patients with an eGFR decrease of 25 % or more from baseline eGFR without need for dialysis. Dialysis dependence was defined as end-stage kidney
disease and permanent need for renal replacement therapy for >3 months
Statistically significant data (P<0.05) are presented in bolditalic
De Corte et al. Critical Care (2016) 20:256 Page 10 of 13
12. in patients with a single AKI-RRT episode but also in
patients with acute-on-chronic kidney disease, this study
provides a key role for nephrological follow-up in such a
cohort of patients. Finally, this study is one of the first to
report on the recently proposed composite endpoint
MAKE. The composite endpoint MAKE was addressed
in detail, not only revealing its benefits but also
highlighting its limitations in this setting. As the study is
monocentric, the conclusions cannot automatically be
extended to other ICUs. Therefore, generalization of
these findings must be considered with caution.
This cohort study has limitations. First, owing to its
observational design, we cannot exclude that there were
unmeasured confounders. Second, the data reflect the
practice at a single tertiary care center and may there-
fore lack external validity. However, the reported AKI-
RRT prevalence of 5.5 % and the hospital mortality rate
in this study cohort are in line with data reported by
units in other developed countries [2, 27]. Third, we
could include only all consecutive patients with AKI-
RRT present in the electronic PDMS, owing to its grad-
ual introduction. Similarly, patients who, because of
therapeutic restrictions, were not started on RRT were
not included in this analysis. Fourth, we had only a refer-
ence creatinine value in 63.4 % of patients. Therefore,
renal recovery and MAKE were assessed in only a sub-
group of patients. Because patients with absent docu-
mentation of a baseline serum creatinine level more
likely have normal kidney function, this analysis was
done in a patient cohort with presumably a higher-than-
normal proportion of patients with preexisting CKD.
This may have impacted our findings. To correct for pos-
sible bias, we performed a sensitivity analysis excluding
baseline kidney function from the Cox regression and
multivariate analyses. This intervention did not change
the HRs and ORs of the covariates included in the model.
Therefore, we may conclude that the possibility of bias in-
troduced by this subgroup analysis may be limited.
Conclusions
We demonstrated poor long-term survival after AKI-RRT
associated with advancing age and clinical status at initi-
ation of RRT. Initiation with CRRT, a surrogate for sever-
ity of illness, was associated with adverse outcome. Renal
recovery was limited and associated with CKD and dia-
betes. Patients with acute-on-chronic kidney disease fre-
quently developed ESRD, making nephrological follow-up
imperative. The majority of patients were classified as
MAKE at 1 year. MAKE was determined mainly by its
biggest component, mortality. CKD as well as timing and
modality of RRT were not associated with MAKE.
Additional file
Additional file 1: Table S1. Cox proportional hazards model. Table S2.
Multivariate regression analysis: MAKE at 1 year. (DOCX 15 kb)
Abbreviations
AKI, acute kidney injury; AKIKI, Artificial Kidney Initiation in Kidney Injury
study; AKI-RRT, acute kidney injury treated with renal replacement therapy;
APACHE II, Acute Physiology and Chronic Evaluation II; CKD, chronic kidney
disease; CRRT, continuous renal replacement therapy; eGFR, estimated
glomerular filtration rate; ESRD, end-stage renal disease; FINNAKI, Finnish
Fig. 4 The composite endpoint major adverse kidney events (MAKE) comprised the components death, dialysis dependence, and incomplete
renal recovery. Renal recovery was defined as incomplete when estimated glomerular filtration rate (eGFR) decreased 25 % or more from baseline
eGFR without need for dialysis. Dialysis dependence was defined as end-stage renal disease and permanent need for renal replacement therapy
for >3 months. CKD chronic kidney disease
De Corte et al. Critical Care (2016) 20:256 Page 11 of 13
13. Acute Kidney Injury study; GFR, glomerular filtration rate; ICU, intensive
care unit; IHD, intermittent hemodialysis; IQR, interquartile range; KDIGO,
Kidney Disease: Improving Global Outcomes; MAKE, major adverse kidney
events; MDRD, Modification of Diet in Renal Disease; PDMS, patient data
management system; RENAL, Randomized Evaluation of Normal versus
Augmented Level Replacement Therapy study; RRT, renal replacement
therapy; SAPS, Simplified Acute Physiology Score; SLEDD, slow extended
daily dialysis; SOFA, Sepsis-related Organ Failure Assessment
Acknowledgements
We thank Chris Danneels and Veerle Brams for data retrieval from the PDMS
and their help in setting up the database.
Authors’ contributions
WDC helped to design the study, participated in data collection and
analysis, and wrote the first draft of the manuscript and revised it. JV, VS, and
SC participated in data collection and reviewed the first draft of the
manuscript. AD, RV, JDW, and JD helped to design the study and revised the
manuscript. EAJH had the original idea for the study, helped to design it,
participated in analysis, and revised the manuscript. All authors read and
approved the final manuscript.
Authors' information
All authors attest to the originality of the text and the originality of any and
all supporting tables and images. All authors made material contributions to
this manuscript according to the rules of authorship of the Critical Care
journal.
Competing interests
The authors declare that they have no competing interests.
Ethics approval and consent to participate
The study was approved by the ethics committee of Ghent University
Hospital and was conducted in accordance with the Declaration of Helsinki.
The need for informed consent was waived for this study.
Author details
1
Department of Intensive Care Medicine, Ghent University Hospital, De
Pintelaan 185, 9000 Gent, Belgium. 2
Department of Anesthesia and Intensive
Care Medicine, AZ Groeninge Hospital, Kortrijk, Belgium. 3
Nephrology
Division, Ghent University Hospital, Ghent, Belgium. 4
Research
Foundation-Flanders (FWO), Brussels, Belgium. 5
Department of Anesthesia,
Stedelijk Ziekenhuis, Aalst, Belgium. 6
Department of Anesthesia, Sint-Jozef
Ziekenhuis Izegem, Izegem, Belgium.
Received: 2 May 2016 Accepted: 15 July 2016
References
1. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al.
Epidemiology of acute kidney injury in critically ill patients: the
multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411–23.
2. Nisula S, Kaukonen KM, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S,
et al. Incidence, risk factors and 90-day mortality of patients with acute
kidney injury in Finnish intensive care units: the FINNAKI study. Intensive
Care Med. 2013;39(3):420–8.
3. Kellum JA, Angus DC. Patients are dying of acute renal failure. Crit Care
Med. 2002;30(9):2156–7.
4. Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the
problem? Crit Care Med. 2008;36(4 Suppl):S146–151.
5. Elseviers MM, Lins RL, Van der Niepen P, Hoste E, Malbrain ML, Damas P,
et al. Renal replacement therapy is an independent risk factor for mortality
in critically ill patients with acute kidney injury. Crit Care. 2010;14(6):R221.
6. Chawla LS, Eggers PW, Star RA, Kimmel PL. Acute kidney injury and chronic
kidney disease as interconnected syndromes. N Engl J Med. 2014;371(1):58–66.
7. Rimes-Stigare C, Frumento P, Bottai M, Martensson J, Martling CR, Bell M.
Long-term mortality and risk factors for development of end-stage renal
disease in critically ill patients with and without chronic kidney disease. Crit
Care. 2015;19:383.
8. Bell M, SWING, Granath F, Schön S, Ekbom A, Martling CR. Continuous renal
replacement therapy is associated with less chronic renal failure than
intermittent haemodialysis after acute renal failure. Intensive Care Med.
2007;33(5):773–80.
9. Uchino S, Bellomo R, Kellum JA, Morimatsu H, Morgera S, Schetz MR, et al.
Patient and kidney survival by dialysis modality in critically ill patients with
acute kidney injury. Int J Artif Organs. 2007;30(4):281–92.
10. Schneider AG, Bellomo R, Bagshaw SM, Glassford NJ, Lo S, Jun M, et al.
Choice of renal replacement therapy modality and dialysis dependence
after acute kidney injury: a systematic review and meta-analysis. Intensive
Care Med. 2013;39(6):987–97.
11. Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K,
Boulain T, et al. Continuous venovenous haemodiafiltration versus intermittent
haemodialysis for acute renal failure in patients with multiple-organ dysfunction
syndrome: a multicentre randomised trial. Lancet. 2006;368(9533):379–85.
12. Wald R, Bagshaw SM. The timing of renal replacement therapy initiation in
acute kidney injury. Semin Nephrol. 2016;36(1):78–84.
13. Amdur RL, Chawla LS, Amodeo S, Kimmel PL, Palant CE. Outcomes
following diagnosis of acute renal failure in U.S. veterans: focus on acute
tubular necrosis. Kidney Int. 2009;76(10):1089–97.
14. Ishani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA, et al.
Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol.
2009;20(1):223–8.
15. Billings FT, Shaw AD. Clinical trial endpoints in acute kidney injury. Nephron
Clin Pract. 2014;127(1-4):89–93.
16. De Corte W, Vuylsteke S, De Waele JJ, Dhondt AW, Decruyenaere J,
Vanholder R, et al. Severe lactic acidosis in critically ill patients with
acute kidney injury treated with renal replacement therapy. J Crit Care.
2014;29(4):650–5.
17. Reynvoet E, Vandijck DM, Blot SI, Dhondt AW, De Waele JJ, Claus S, et al.
Epidemiology of infection in critically ill patients with acute renal
failure. Crit Care Med. 2009;37(7):2203–9.
18. Zavada J, Hoste E, Cartin-Ceba R, Calzavacca P, Gajic O, Clermont G, et al. A
comparison of three methods to estimate baseline creatinine for RIFLE
classification. Nephrol Dial Transplant. 2010;25(12):3911–8.
19. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1–150.
20. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of
disease classification system. Crit Care Med. 1985;13(10):818–29.
21. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology
Score (SAPS II) based on a European/North American multicenter study.
JAMA. 1993;270(24):2957–63.
22. Vincent JL, Moreno R, Takala J, Willatts S, de Mendonça A, Bruining H, et al.
The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ
dysfunction/failure. Intensive Care Med. 1996;22(7):707–10.
23. RENAL Replacement Therapy Study Investigators. Intensity of continuous
renal-replacement therapy in critically ill patients. N Engl J Med. 2009;
361(17):1627–38.
24. VA/NIH Acute Renal Failure Trial Network. Intensity of renal support in
critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7–20.
A published erratum appears in N Engl J Med. 2009;361(24):2391.
25. Venot M, Weis L, Clec’h C, Darmon M, Allaouchiche B, Goldgran-Toledano D,
et al. Acute kidney injury in severe sepsis and septic shock in patients with and
without diabetes mellitus: a multicenter study. PLoS One. 2015;10(5):e0127411.
26. Bagshaw SM, Berthiaume LR, Delaney A, Bellomo R. Continuous versus
intermittent renal replacement therapy for critically ill patients with acute
kidney injury: a meta-analysis. Crit Care Med. 2008;36(2):610–7.
27. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al.
Acute renal failure in critically ill patients: a multinational, multicenter study.
JAMA. 2005;294(7):813–8.
28. Wald R, Adhikari NK, Smith OM, Weir MA, Pope K, Cohen A, et al.
Comparison of standard and accelerated initiation of renal replacement
therapy in acute kidney injury. Kidney Int. 2015;88(4):897–904.
29. Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstadt H,
et al. Effect of early vs delayed initiation of renal replacement therapy on
mortality in critically ill patients with acute kidney injury: the ELAIN
randomized clinical trial. JAMA. 2016;315(20):2190–9.
30. Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al.
Initiation strategies for renal-replacement therapy in the intensive care unit.
N Engl J Med. 2016;375(2):122–33.
31. Joannes-Boyau O, Honoré PM, Perez P, Bagshaw SM, Grand H, Canivet JL,
et al. High-volume versus standard-volume haemofiltration for septic shock
De Corte et al. Critical Care (2016) 20:256 Page 12 of 13
14. patients with acute kidney injury (IVOIRE study): a multicentre randomized
controlled trial. Intensive Care Med. 2013;39(9):1535–46.
32. Hsu CY, Chertow GM, McCulloch CE, Fan D, Ordonez JD, Go AS.
Nonrecovery of kidney function and death after acute on chronic renal
failure. Clin J Am Soc Nephrol. 2009;4(5):891–8.
33. Sawhney S, Mitchell M, Marks A, Fluck N, Black C. Long-term prognosis after
acute kidney injury (AKI): what is the role of baseline kidney function and
recovery? A systematic review. BMJ Open. 2015;5(1):e006497.
34. Gallagher M, Cass A, Bellomo R, Finfer S, Gattas D, Lee J, et al. Long-term
survival and dialysis dependency following acute kidney injury in intensive
care: extended follow-up of a randomized controlled trial. PLoS Med. 2014;
11(2):e1001601.
35. Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE. The severity of
acute kidney injury predicts progression to chronic kidney disease. Kidney
Int. 2011;79(12):1361–9.
36. Kellum JA. How can we define recovery after acute kidney injury?
Considerations from epidemiology and clinical trial design. Nephron Clin
Pract. 2014;127(1-4):81–8.
37. Palevsky PM, Molitoris BA, Okusa MD, Levin A, Waikar SS, Wald R, et al.
Design of clinical trials in acute kidney injury: report from an NIDDK
workshop on trial methodology. Clin J Am Soc Nephrol. 2012;7(5):844–50.
38. Kashani K, Al-Khafaji A, Ardiles T, Artigas A, Bagshaw SM, Bell M, et al.
Discovery and validation of cell cycle arrest biomarkers in human acute
kidney injury. Crit Care. 2013;17(1):R25.
39. Cordoba G, Schwartz L, Woloshin S, Bae H, Gotzsche PC. Definition,
reporting, and interpretation of composite outcomes in clinical trials:
systematic review. BMJ. 2010;341:c3920.
• We accept pre-submission inquiries
• Our selector tool helps you to find the most relevant journal
• We provide round the clock customer support
• Convenient online submission
• Thorough peer review
• Inclusion in PubMed and all major indexing services
• Maximum visibility for your research
Submit your manuscript at
www.biomedcentral.com/submit
Submit your next manuscript to BioMed Central
and we will help you at every step:
De Corte et al. Critical Care (2016) 20:256 Page 13 of 13
View publication stats
View publication stats